Personal Information

References

CONDITIONS OF EMPLOYMENT:

Consent to Background and Reference Check

I hereby authorize Ultra Personnel LLC (the "Company") of 7348 Mentor Avenue, Mentor, Ohio 44060, and/or its agents to make investigation of my background, references, character, past employment, consumer reports, education, and criminal history record information which may be in any state or local files, including those maintained by both public and private organizations, and all public records, for the purpose of confirming the information contained on my application and/or obtaining other information which may be material to my qualifications for employment. A telephone facsimile (fax) or xerographic copy of this consent shall be considered as valid as the original consent.

I hereby consent to the Company's verification of all the information I have provided on my application form. I also agree to execute as a condition of employment or a condition of continued employment any additional written authorization necessary for the Company to obtain access to and copies of records pertaining to this information. I also hereby authorize the Company's access to any medical histories or records pertaining to me (and any other individuals who due to my employment may be covered by any Company medical or other insurance program). With regard to the foregoing disclosures, I hereby agree to release any person, company, or other entity from any and all causes of action that otherwise might arise from supplying the Company with information it may request pursuant to this release. I understand that any false answers or statements, or misrepresentations by omission, made by me on this application or any related document, will be sufficient for rejection of my application or for my immediate discharge should such falsifications or misrepresentations be discovered after I am employed.

If working on assignment for Ultra Personnel, the location at which you are placed will provide us with your hours worked each week. Your pay is calculated on the hours that the client provides to us. If you feel there are any discrepancies in your check, you must notify Ultra Personnel before the end of the same week of which you received your check.

Your official pay day is THURSDAY of each week. Please note that Holiday weeks may mean an alternate pay day; Ultra Personnel will advise you in advance of any changes. Pay checks will be delivered to your work location, unless we are otherwise notified that you will pick it up at the Ultra Personnel office during regular business hours.

To the best of my knowledge, the information contained in this document is true and accurate, and I understand that if I have given false or misleading information, I shall be subject to dismissal regardless of the time elapsed after discovery.

I authorize Ultra Personnel to inquire into my educational, professional and past employment history, as well as a reference check, and a background check or credit check if need be, in order to research my qualifications for any given position.

I also give my consent to any former employer to provide related information about me to Ultra Personnel. I understand that this is not a binding contract between myself and Ultra Personnel, and that employment can be terminated at any time by either party. I hereby acknowledge that I have read and agree to the statements listed in this employment application. Ultra Personnel is an equal opportunity employer.

Professional and Educational Information

Education

Employment History

Please check any of the following boxes if you have experience in the area.

Substance Abuse Policy

Ultra Personnel is committed to maintaining a safe, healthy, and efficient working environment. The use, sale, possession, purchase, or transfer of drugs, or the use of alcohol in the workplace poses unacceptable risks to safe and efficient operations. This policy prohibiting workplace substance abuse is designed to ensure employee safety, reduce absenteeism and tardiness, improve productivity, and protect the company’s status and reputation.

Employees are expected and required to report to work on time and in appropriate mental and physical condition. The unlawful use, possession, manufacture, distribution, or dispensation of drugs on company premises or while conducting company business off premises is strictly prohibited.

Possession or use of alcohol on company premises, except in connection with company authorized events, is strictly prohibited.

The undisclosed use of legal drugs by employees while on the job is prohibited, however; employees can use prescribed medications while performing their jobs IF Ultra Personnel determines beforehand, that such use does not pose a safety risk. Employees whose physicians have prescribed medications that might adversely affect their ability to perform their work must provide a written statement from their doctor(s).

Ohio House Bill 523, effective September 8, 2016, legalizes medical marijuana in Ohio for certain medical conditions. However, nothing in the law requires an employer to accommodate and employee’s use of medical marijuana and the law does not prohibit an employer from refusing to hire, discharge, or taking an adverse employment action because of a person’s use of medical marijuana. Further, any employee that is injured at work and the injury is the result of being intoxicated or under the influence of marijuana or other drugs, is not eligible for Worker’s Compensation (whether or not the use was recommended by a physician).

Employees needing help in dealing with substance abuse problems are encouraged to seek professional rehabilitation services. Records of absences to seek treatment or insurance claims for covered treatment will be maintained, although the reasons for the absences or claim will be kept confidential and disclosed only on a need-to-know basis.

If the company, or any client at which you are assigned, has reason to suspect that an employee (including temporary or contracted employees) is under the influence of alcohol and/or a controlled substance in the normal course of conducting business on the company’s behalf, the company may require a drug and/or alcohol test. An employee’s (including temporary or contracted employees) refusal to comply with such testing will result in discharge/termination.

I acknowledge and understand that any violation of this policy will result in disciplinary action, up to and including discharge/termination, as well as possible criminal consequences.

Ohio Concealed Weapons Law

In order to ensure the safety of all employees, vendors, and customers, it is necessary for us to address the Ohio Concealed Weapons Law as it relates to your temporary employment with our company. Because of media attention to this subject, many of you are already aware that the state of Ohio has a concealed weapons law giving abiding citizens and mentally competent Ohioans, 21 and older, the right to carry concealed handguns. It is because of this law that we are bringing to your attention, Ultra Personnel’s written policy as it pertains to weapons.

The company’s policy prohibits the possession of firearms or other weapons on company property. Company property includes not only our business and offices but is extended to include the entire premises including the parking lot, green areas, company vehicles, and any place in which any employee may be performing duties associate with their employment with our company. This includes any location at which you are assigned a job; their premises, offices, parking lot, green areas, company vehicles, and any place in which you may be performing duties associated with your assignment.

Failure to comply with this policy will result in disciplinary action up to and including discharge/termination.

Third party visitors to the company are also prohibited from carrying firearms and other weapons on company property.

If you have any questions regarding this information or you do not understand the contents of this memo, we strongly encourage you to discuss your concerns with your recruiter.